血管内超声在缺血性脑血管疾病支架置入过程中的应用与评价

Application and evaluation of intravascular ultrasound in ischemic cerebrovascular disease during stent implantation

目的:脑血管内支架置入已逐渐成为治疗缺血性脑血管疾病一种重要方法,但支架置入后的再狭窄成为当前疾病治疗的主要局限。为此对超声在判断和减少血管支架置入再狭窄的应用效果和价值进行探讨。方法:由第一作者检索维普数据库和中国期刊全文数据库有关缺血性脑血管疾病支架置入的超声评价方面的文献,共检索到22篇文献,对资料进行初审,最终纳入6篇进行分析。纳入标准:①血管内超声在颈动脉支架置入前的应用。②血管内超声指导支架置入及其效果评价。③彩色多普勒超声及经颅彩色多普勒超声对颈动脉支架置入后近期及远期效果的评价。排除标准:较陈旧的文献和重复研究。结果:①血管内超声在支架置入前可精确测量血管管腔的狭窄程度、狭窄长度及血管腔面积,以便选择大小、长度适合的支架,指导支架行之有效的放置。②血管内超声探头可以观察到支架扩张是否完全,扩张后的支架是否对称,精确测量扩张后支架的大小以及支架与血管壁的紧贴程度。③彩色多普勒超声及经颅彩色多普勒超声可以监测血管支架置入后的近期及远期效果,早期发现、早期治疗,减少血管再狭窄的发生。明确血管支架内发生再狭窄的原因,指导对支架内发生再狭窄的治疗,降低再狭窄的发生率,进一步改善支架置入效果。结论:血管内超声弥补了数字减影血管造影的不足,在其指导下的支架置入可获得较大的支架面积和较小的再狭窄率。在血管支架置入后,血管内超声可准确检测支架的扩张程度及血管壁内贴壁情况,彩色多普勒超声及经颅彩色多普勒超声定期监测支架内的血流情况,对血管内支架置入后再狭窄的评估及预防再狭窄具有重要的应用价值。

OBJECTIVE： Cerebral endovascular stent implantation has become an important method to treat ischemic cerebrovascular disease. However, its application has been limited by restenosis following implantation. The effect and significance of ultrasound in identifying and reducing restenosis following endovascular stent implantation was explored. METHODS： A computer-based online search of VIP database and CNKI database was performed for articles recording ultrasound evaluation of ischemic cerebrovascular disease following endovascular stent implantation. A total of 22 articles were collected, and 6 were included. Inclusion criteria： application of intravascular ultrasound in carotid artery stent implantation; guidance and effect evaluation of intravascular ultrasound; short- and long-term effect evaluation of carotid artery stent implantation by color Doppler ultrasound and transcranial Doppler ultrasound. Exclusion criteria： outdate and repetitive studies. RESULTS： Intravascular ultrasound can precisely measure vascular lumina stenosis degree, stenosis length and luminal area before stent implantation to select stent with appropriate size and length and effectively guide stent implantation. Intravascular ultrasound probe can observe stent expansion, expansion symmetry, and precisely determine expanded stent size and attachment of stent to the vessel wall. Color Doppler ultrasound and transcranial Doppler ultrasound can monitor the short- and long-term effect of stent implantation so as to discover, treat and reduce restenosis as early as possible, confirm causes for restenosis foltowing stent imptantation, guide treatment of restenosis, reduce incidence of restenosis and improve stent implantation effect. CONCLUSION： Intravascular ultrasound remedies disadvantages of digital subtraction angiography, increases stent extension area and reduces incidence of restenosis. Following stent implantation, intravascular ultrasound can accurately detect stent expansion degree and attachment of stent to the vessel wall; Color Doppler ultrasound and transcranial Doppler ultrasound can monitor blood follow in stent, and play an important role in evaluating restenosis and preventing restenosis following endovascular stent implantation.